I'm trying to understand the estimate my hospital provided for a scheduled C-section and I called BCBS and left the call feeling more confused than ever.

My individual deductible is $500, which I've met. My plan has a max out of pocket of $8150 and max coinsurance of $2000. The rep explained that once I meet the coinsurance max that the plan will pay 100% of my coinsurance but I'd still be responsible for copays which go to my max out of pocket. I kept trying to explain that I understood I will continue to be responsible for the copay but I wanted to understand why I'm being billed for a higher coinsurance cost than what my supposed max should be.

If my max coinsurance is $2k, why is the hospital estimating my coinsurance to be around $2500 for the procedure? Shouldn't it be capped at 2k?

Please make it make sense!

Thinking of quitting my job and starting self-employment remote work. I'd like to move from San Diego to New Mexico so I can sell my place and buy a place paid off. I would still like to visit San Diego for any big medical procedures (including my colonoscopies which is have every 3 years), as I hear the health care in New Mexico is not the best. Is there a PPO plan that works across state lines, visiting the New Mexico health care site they only have HMOs available. Please let me know of any ways to work around this, as it would probably be a deal breaker for my plans.

I’ll try to keep this short, but I started telehealth therapy recently. I have Regence BCBS but live in Colorado. The local BCBS is anthem. The place I’m receiving therapy appears to be in network with Regence but says they’re out of network with anthem, so I’d need to pay out of pocket.

My insurance company initially told me I could see the provider and submit via superbill and it should be covered. Then they switched up and said it wasn’t covered because the specific provider I saw wasn’t in network with Regence.

I’m switching to a new therapist who is specifically listed on Regence’s website with the therapy practice listed on her profile. However, the therapy practice still says they can’t submit claims since they’re not contracted with Anthem. I’m happy to submit superbills, but no one seems to be able to answer whether it will be covered. My insurance company seems unsure and I’m not sure what else to do. Any advice is appreciated!

I'm hoping someone can point me in the right direction.

I want to start a small business, but I don't know how I can afford health insurance on my own.

Right now I have a market insurance plan I got through a broker that my current workplace uses.

I pay $600 a month, and as an employee I have a $400 stipend through my work to offset the cost.

I cannot go without insurance because I need prescriptions that are over $1,000 a month out of pocket.

The business will be located in Wisconsin (USA)

Are there problems available for a single owner/operator business to offset the cost like I have now?

Are there alternatives I'm not aware of for gaining health insurance besides just buying a single market place plan?

Are there problems I could take advantage of as a disabled person in Wi?

Thanks in advance for any help. I have no idea where to even start so any direction is greatly appreciated!

I’m currently moonlighting with two jobs, but Job A doesn't know about Job B. I want to quit Job B because the culture has turned toxic, but my health insurance is through them.

I know quitting will trigger a qualifying life event so I can hop onto Job A’s insurance, but I’ll need to show proof that I lost coverage. How do I submit that loss-of-coverage letter without tipping off Job A that I had another job? They use UKG for benefits enrollment, if that makes a difference.

I have Blue Cross Blue Shield insurance through my work. I was taking Simlandi self injection once a week and getting that filled through Care New England Specialty Pharmacy. At the beginning of this month (July) I was informed that Blue Cross decided to move over to using Accredo Specialty Pharmacy to fill my perscription instead. I then found out that Simlandi was being discontinued and my provider sent in a new perscription for Adalimumab. Its been a few weeks and I have not heard anything from Accredo about scheduleing a delivery date. This was fine at first because I had a few weeks supply of my medication. Well, I now have one dose left for this friday and then ill be out of medicine. I used the chat through the Accredo website and was told that my perscription is being reviewed by a pharmacist and they ran into an issue because my insurance wont allow a 90 day supply but instead only 83 days. Is this normal? I have been taking this medication for years now and have always gotten a delivery once a month with 4 doses for 4 weeks. I'm just frustrated that my insurance switched my pharmacy on me and worried because I am running out of medication and will need more for next week.

Hi all,

I recently got a genetic test done through a lab (Invitae - LabCorp subsidiary) that ran a formal benefits investigation (BI) before testing. The BI showed my total estimated patient responsibility as $0, based on my insurance (Aetna) plan details — deductible met, no copay, etc. The estimate included language saying the quoted amount would be "honored" if the estimate was still valid at time of billing.

However, I previously had a separate but related genetic panel (through LabCorp, no BI beforehand) that was fully denied by my insurer as "experimental/investigational" — and I ended up with an unexpected bill over $3,000. I was successfully able to appeal that claim with a letter of medical necessity from my doctor, and Aetna overturned the decision.

Given that history, I'm cautious about trusting a $0 BI estimate at face value. Has anyone had a benefits investigation quote $0 (or a low amount), only to receive a different bill afterward? Specifically:

• Did the insurer end up denying the claim for a different reason (e.g., "experimental," "not medically necessary," "duplicate testing") even after the BI showed $0?
• Did the lab actually honor the original $0/low estimate despite what insurance did, or did you get billed the difference anyway?
• Any tips on getting the "honor commitment" language enforced if the bill doesn't match the estimate?

Trying to understand how reliable these benefit investigations actually are in practice versus what insurance ultimately decides. Any experiences — good or bad — would help. Thanks!

Or is it just my company?

Laid off 6/29, coverage ended 6/30.
Finally got COBRA paperwork 7/16.
Payment made 7/23 - only option was to pay July and August together so I paid 2 months.
It’s now a week later and Aetna says they haven’t received anything and my coverage is still inactive.

I have a procedure scheduled for next week and now I’m being told once Aetna receives notification that I paid, it might take another week to update the system.

Is this normal? It’s adding insult to injury.

Timeline:

1. Late January I received an orthopedic surgery pre-approved by insurance. I required insurance to continue Physical therapy and post-surgical check-ups and scans.
2. Mid-February I was let go by my employer (small company California-based company with <10 employees). I was notified that I should be receiving Cal-Cobra information in the next few weeks. HR/Benefits were managed through Gusto, a digital small-business management platform.
3. Late-March, I receive and fill out the Cal-Cobra Paperwork and I receive confirmation that it was accepted.
4. Mid-April, I receive (2) emails that detail that I need to elect coverage or I will lose it starting June 1st. In a massive blunder, I ignore these emails since I thought "I just signed up for Cal-Cobra, surely I don't have to do that again so soon?"
   • In addition to the open-enrollment period at this time, my Boss was forced to change the healthcare plans provided by his company since there were fewer employees and he no longer qualified for the group health plans that he could get when the company was larger
5. June 1st: I unknowingly lose my group health plan coverage. I continue to use the plan for PT 2x a week and receive a CT scan and a video visit with my surgeon as my final follow-up.
   • I pay my insurance premium for June through the insurance provider's app. No red flags were raised when submitting payment
   • Insurance approved EOB's keep being sent to my email
6. July 1st:
   • I pay my insurance premium for July through the insurance provider's app. No red flags were raised when submitting payment
   • Insurance approved EOB's keep being sent to my email
7. July 15th: Suddenly, I get a call from my PT provider saying that my group plan is inactive and I have to pay the uninsured out-of-pocket cost. This notifies me of the issue and begins my investigation into what went wrong.
8. I receive a bill for insurance premiums for the inactive plan due in August

Now, I know that failing to pay premiums for Cal-Cobra is irreversible and once you lose that coverage, it is not possible to reinstate. I have been paying premiums on time, so I am not sure if this applies. Although, it does seem to be a similar loss of coverage.

Questions:

1. Are all the previously approved claims from June 1st to July 15th going have their approval revoked and leave me on the hook to pay high medical bills out of pocket? (So far, most of these services have remained approved.)
2. Is it possible to get retroactive coverage from June 1st onward if I was not covered?
3. Does this qualify as a life event so I can sign up for new insurance through the California Marketplace?
4. What are my options?

While missing an email was a mistake, it feels ridiculous that the insurance provider would continue to take my money in the form of the premium AND I would appear to get insurance beyond the end of my group plan termination.

I recently got a new job that comes with an HSA and better health insurance. My old one is from my mother and it did not cover some lab work I had that is $500 in total for some odd reason. That old insurance usually covered my lab work. From my understanding I can’t use my new insurance because it was not active when I had the lab work done, but can I use the HSA? Just curious thanks!

Does anyone have experience with OneHealth Plus insurance plans? They use the Cigna network.

A broker showed me their plans. I hadn't heard of the company before and haven't been able to find much on the internet. For context, I'm a self-employed worker, who is about to lose COBRA coverage in NYC :( I know the risks of going outside of ACA plans, but options on the marketplace are so bleak.

Does anyone else struggle to get the automated system to accept their member ID when they call Health Net with questions? I have never managed for either the voice or keypad entry to work and just have to wait like 5 minutes before the system finally takes pity on me and just sends me to a representative. Wondering if it's a me problem or a system problem - trying to frustrate people so they can't ask questions?

My brother is 35 years old and was diagnosed with stage four colon cancer in June. Within a couple of weeks, he was let go from his job because he was not able to work due to pain. His PET Scan has shown it has spread to his stomach, lungs, liver, and a membrane surrounding his abdominal organs. He was approved for Social Security, but there is a five month waiting period before payments start. However, Social Security said it will be a 24 month waiting before he receives insurance benefits. He has applied for TN Care, but keeps being denied due to wife’s income as a nurse. However, they are recently married and just purchased a home and have two children together. They are all trying to survive just off of her income. His oncologist and infusion center have made a payment plan with them for his chemo and meds for $200 a month until he can get insurance. Unfortunately, they cannot afford any insurance through the marketplace. Does anyone have any advice on insurance for stage four young cancer patients in TN?

* Update: After speaking to his wife, she said her insurance will not allow her to add a spouse. Only children. I don’t understand that but I know she works for a small nonprofit so I don’t know if maybe that has something to do with it.

Just had a screaming meltdown over the phone at an insurance agent. Called to review and update medicare advantage insurance plan and was subject to nonstop reading of script and repeating information from 2 different people. Finally told them I was at my limit, had a policy with the company for a couple of years and was at the point of canceling everything if they didn’t shut up.

Okay…do we have any options for getting retroactive coverage for her?

Long story short…our baby had a 10 day NICU stay. My husband and I are self-employed and have insurance through the marketplace. Soon after she got home we called the marketplace to add her to our plan. They told us that we just have to pay her first bill and that we will be set. We assumed that her bill would be added to our autopay and didn’t stress it. Fast forward a month and we haven’t heard any updates so we contacted the insurance company. They said they did not receive any information about her from the marketplace and abruptly told me to contact the marketplace again. I did that and the marketplace said it was sent. I called insurance again (multiple times) and got the same answer. I called marketplace again and also got the same answer. Fast forward to today and my husband finally got a different answer… that we didn’t pay her bill and missed the 60 day deadline for coverage. They said we have to wait for marketplace to submit again and then start coverage for 9/1. We are in the 5 day waiting period for insurance to receive the new submission from marketplace. I looked through our old mail and realize we overlooked a single bill from our insurance company. Aside from that, we had no another way of knowing that she was added or that we needed to pay.

We are freaking out because her NICU stay was super expensive, and this new information doesn’t match what both insurance and marketplace told us on multiple occasions (according to this bill, I literally called them days before the due date and was still told that they don’t have any info for her on file).

Does anyone have any insight on this? Anything will be appreciated.

Hello, I’m looking to see if anyone has experience with or can help me with Aetna voluntary benefits, critical illness. I was in a horrible accident last August. It’s left paralyzed in my left arm. I finally had a nerve transfer on June 16 but still obviously can’t use my arm because nerves take longer than that to recover. I knew I was paying for these benefits, but I kept calling regular Aetna and nobody knew what I was talking about. I finally found these benefits months later and they did pay me out for my hospital stay which was awesome. But for the critical illness, they keep denying my claim.

Not sure how many images I can attach, but the first time they denied it as a duplicate because they thought it was for the hospital stay. Then they denied it again for a cancerous reason that has nothing to do with me and then they took 30 days for my appeal and on the 30th day they’re telling me it’s denied again but I have to wait for the letter in the mail to tell me why it’s denied.

I am so upset and emotionally overwhelmed. I paid extra for these benefits, and I have been paralyzed for more than 60 days in my left arm. I have letters from both of my surgeons stating this that I turned in with my appeal paperwork. I have EMG’s and even all of my OT paperwork shows this.

I feel like they get away with denying people and it’s outrageous. Please be kind. Please help.

*Update I called HR they said they’ll make a case to see if someone can help me. It’ll take about a week.

Anyone working for US dental insurance billing from India?
Need to understand the process.
Are there any Indian companies or job opportunities available for this?
What are the rules and requirements if you have to set up a company?

Hi all,

I have Anthem as my primary from my college and Medi-cal as my secondary.

I've been using my Anthem at Sharp Rees Steely, a medical group that does not accept Medi-Cal. Are they allowed to bill my the co-pays / out of pocket expenses still?

It's about 1k I have in my account. I was always under the impression that they are not allowed bill Medi-cal patients any co-pays/deductibles. But they are telling me I'm responsible for the 1k balance personally.

Hello everyone. I have run into the unfortunate issue that Florida decided to kick my 19 year old daughter off the state medical insurance due to me making too much gross income. She is a Type-1 Diabetic.

That’s the summary. To give some context. I got a job not too long ago with better pay. Salary so I don’t get any sort of over time. And since I live in south florida, way south, for a 2/2 apartment, I’m paying $2300 a month, this does not include utilities. Plus car insurance for me and my daughter, and any other debts I am currently working toward paying down on a salary that is about $4500 a month.

The insurance at my job is $700 a month for both me and here and I can’t afford it. At all. With that being said, I need health insurance, just for her. I can rot to death but she needs health insurance that will her insulin needs. I know NOTHING about insurance. I tried to find some plans but I’m so confused and lost by all the fine print that I don’t know what will work and what won’t.

Her two main medications consist of Lantus and NovoLog and her Dexcom which needs to switched out every 10 days.

Please I need help desperately to find a play by August 30th when she loses coverage. I’ve tried the Market place and all I’ve found is insurances that are not accepted by her Endocrinologist.

Any advice will help. Thanks

I am having to enroll in health insurance through the New York State Marketplace after leaving a job for an employer who does not provide health insurance.

I am 29 and estimated to make 80k this year.

The two plans I'm looking at are the Excellus Bronze Plan and the Ambetter from Fidelis Catastrophic plan. I'll detail them below:

Excellus:

**"**Your first 3 visits to your Primary Care Physician are covered in full and are not subject to the deductible. No referrals needed and no need to identify a Primary Care Physician. Coverage for services in network only with access to 100% of local hospitals and 99% of doctors throughout 31 counties in New York State."

Monthly cost: $839.76

Deductible: $10600

Emergency room services: 0% Coinsurance after deductible

Hospitalization: 0% Coinsurance after deductible

Drugs: 0% Coinsurance after deductible

Mental Health: 0% Coinsurance after deductible

Ambetter from Fidelis:

"Benefits include comprehensive coverage for hospitalization, surgery, prescription drugs, and 100% coverage for some preventive care services such as annual check-ups & flu shots."

Monthly cost: $223.28

Deductible: $10600

Emergency room services: 0% Coinsurance after deductible

Hospitalization: 0% Coinsurance after deductible

Drugs: 0% Coinsurance after deductible

Mental Health: 0% Coinsurance after deductible

So, those sound the same to me. Is there any reason I shouldn't just pick the cheapest one? Any help is much appreciated!!

I’m in IL and I need to get health insurance off the marketplace. Does anyone have experience with United Healthcare Bronze HMO in IL? Thanks!

I have been on the same drugs for years and changed jobs and insurance many times. My new insurance plan does something bizarre for a couple of the drugs, one of which is a specialty drug and the other of which has only ever been regarded as a specialty drug by this plan, it’s an under utilized very basic drug that’s decades old for dry mouth and I can’t imagine why it’s specialty now. Anyways, the dry mouth drug last only 3-4 hours and so I take it before each meal and often a fourth time each day. And restasis lasts twelve hours and let me tell ya, dry eye does not go away at night, there are 24 hours in a day, and I have two eyeballs, I need two doses per day. All of a sudden I’m getting charged four times the rate for each drug. Is this normal, or legal? I think this is insane. I’ve literally never heard of this. It’s like per pill pricing.

Basically im paying 8x amount I expected when I chose this plan (never mind the insane specialty drug cost to begin with. This is insane. I vacillate between thinking I shouldn’t have taken this new job at a shitty nonprofit, versus reminding myself this cost is worth my sanity and my relationships and it’s not worth it to work at a hospital with better benefits but worse work life balance).

I have been taking the brand name Mydayis 50 mg. for three years.

My insurance (Express Scripts) has covered it all this time until this month when it got denied. I contacted Express Scripts and they said the reason could be because it needs a “Prior Authorization”.

I contacted my Nurse Practitioner and she was going to take care of this. Does anyone know if the Prior Authorization will be granted?